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How Do I Know If My Breast Cancer Has Returned

Locally Advanced Breast Cancer Prognosis

Cancer Returns for Breast Cancer Survivor Years Later

If breast cancer has come back and spread to the tissues and lymph nodes around the chest, neck and under the breastbone, there may be an increased risk of cancer cells spreading to other areas of the body.

This means the overall prognosis can be harder to predict.

Treatments such as chemotherapy, hormone and targeted therapies are given for locally advanced breast cancer because they work throughout the whole body.

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Life With Recurrent Cancer

Many people worry that their cancer will return. A study from the American Cancer Society found that a year after being diagnosed, around 2/3 of people were concerned about their disease coming back.

Some cancers come back only once, while others reappear two or three times. But some recurrent cancers might never go away or be cured.

This sounds scary, but many people can live months or years with the right treatment. For them, the cancer becomes more like a chronic illness, such as diabetes or heart disease.

While it may be hard not to fret, try to stay positive and remember that your situation is unique. And as treatments improve, so does the outlook for recurrent cancer.

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Axillary Lymph Node Dissection

In this procedure, anywhere from about 10 to 40 lymph nodes are removed from the area under the arm and checked for cancer spread. ALND is usually done at the same time as a mastectomy or breast-conserving surgery , but it can be done in a second operation. ALND may be needed:

  • If a previous SLNB has shown 3 or more of the underarm lymph nodes have cancer cells
  • If swollen underarm or collarbone lymph nodes can be felt before surgery or seen on imaging tests and a FNA or core needle biopsy shows cancer
  • If the cancer has grown large enough to extend outside the lymph node
  • If the SLNB is positive for cancer cells after chemotherapy was given to shrink the tumor before surgery

What Are The Warning Signs Of Cancer Recurrence

How Do I Know If My Breast Cancer Has Returned

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If youve successfully completed chemotherapy, radiation, or another cancer treatment, you likely want to breathe a sigh of relief and get back to living a more normal life.

As exciting as remission can be, some cancer survivors experience a recurrence of the disease. The chances of a cancer recurrence depend on the type of cancer you had. And the warning signs of a recurrence in cancer survivors may vary by person.

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What Factors Determine The Likelihood Of A Recurrence

Prognostic indicators are characteristics of a patient and her tumor that may help a physician predict a cancer recurrence. These are some common indicators:

  • Lymph node involvement. Women who have lymph node involvement are more likely to have a recurrence.
  • Tumor size. In general, the larger the tumor, the greater the chance of recurrence.
  • Hormone receptors. About two-thirds of all breast cancers contain significant levels of estrogen receptors, which means the tumors are estrogen receptor positive . ER-positive tumors tend to grow less aggressively and may respond favorably to treatment with hormones.
  • Histologic grade. This term refers to how much the tumor cells resemble normal cells when viewed under the microscope the grading scale is 1 to 4. Grade 4 tumors contain very abnormal and rapidly growing cancer cells. The higher the histologic grade, the greater chance of recurrence.
  • Nuclear grade. This is the rate at which cancer cells in the tumor divide to form more cells. Cancer cells with a high nuclear grade are usually more aggressive .
  • Oncogene expression. An oncogene is a gene that causes or promotes cancerous changes within the cell. Tumors that contain certain oncogenes may increase a patient’s chance of recurrence.

What Can You Expect From Treatment

If it is possible to completely remove the tumor and there are no distant metastases, even recurrent breast cancer can be cured.

The odds of being able to get recurrent breast cancer under control depend on a lot of factors, including the following:

  • The size of the tumor
  • Whether it is confined to the breast tissue and where in the breast it is located
  • Whether the tumor growth is affected by hormones
  • Whether the cancer cells have growth factor receptors on them
  • How much the cancer cells have mutated
  • How many cancerous growths there are
  • Whether the cancer cells have spread through the lymph vessels in the skin
  • Whether all of the tumor tissue can be removed
  • Whether it has already spread to other parts of the body
  • How long ago breast cancer was first diagnosed

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Dcis Can Be Removed With Surgery

DCIS can often be removed via a lumpectomya surgery that spares the surrounding breast tissue.

When performing a lumpectomy, surgeons aim to remove all of the cancerous cells, plus a two-millimeter margin of healthy cells around the tumor. This helps ensure that the cancer is 100% removed, and lowers the risk of a recurrence.

Because some DCIS may never progress, some patients may also opt to skip surgery, adopting a watch-and-wait approach instead.

Why Cancer Might Come Back

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Cancer might come back some time after the first treatment. This idea can be frightening. There are different reasons for why cancer might come back. These reasons are:

  • the original treatment didn’t get rid of all the cancer cells and those left behind grew into a new tumour
  • some cancer cells have spread elsewhere in the body and started growing there to form a tumour

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What Are The Effects Of Treatment

Removing lymph nodes from the area around the affected breast and the armpit can cause lymphedema. This is where the arm or chest on the affected side becomes swollen because lymph fluid builds up there. It is important to treat lymphedema as soon as possible because symptoms can get worse over time and then become more difficult to treat.

Depending on how extensive surgery was, the wound may be painful and heal slowly, and there will almost always be visible scarring. Surgery may also make the skin less sensitive and make it more difficult to move the shoulder. One common side effect of cancer treatment is debilitating physical and mental exhaustion.

Losing one or both breasts is a tough blow for a lot of women. The breast is a symbol of femininity, sexual attractiveness and maternity. Losing a breast may stoke fears of no longer being attractive or able to enjoy sexuality, or women may even worry that their partner will leave them. So it can be worth getting a second opinion and looking over more information before deciding whether or not to have surgery. After a breast is removed, it may be possible to reconstruct it through surgery. There is usually no need to rush into a decision.

Breast Cancer Is A Heterogeneous Disease

Based on the presence or absence of the oestrogen receptor and progesterone receptor , and the expression and amplification of the human epidermal growth factor receptor type 2 , breast cancer can be divided into three clinical subtypes: hormone-receptor -positive , HER2-positive and triple-negative ., In the United States, 71% of breast cancers are HR+, 17% are HER2+ and 12% are TN. Following the discovery of five intrinsic molecular subgroups of the disease based on a 50-gene expression classifier luminal A, luminal B, HER2-enriched, basal-like and normal-likeit became apparent that a large degree of unappreciated molecular heterogeneity exists across and within each subtype of breast cancer. While TN and HER2+ patients often present with basal-like and HER2-enriched cancers, respectively, HR+ women are usually diagnosed with luminal A or luminal B tumours. However, despite sharing some common traits, luminal A cancers are generally ER+, PR high and Ki67 low, resulting in low-grade, slow-proliferating neoplasms, whereas luminal B tumours are typically ER+, PR variable and Ki67 variable, translating into more aggressive cancers with a higher proliferative rate.

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What Are The Complications Of Breast Cancer Recurrence

Breast cancer that comes back can be harder to treat. The same therapy isnt always effective again. Tumors can develop a tolerance to certain treatments like chemotherapy. Your healthcare provider will try other therapies. You may be able to try drugs under development in clinical trials.

If breast cancer spreads to other parts of the body, your healthcare providers still treat it like breast cancer. For instance, breast cancer cells that move to the lungs cause breast cancer in the lungs not lung cancer. Metastatic breast cancer is more difficult to treat than cancer in only one part of the body.

You may feel stressed, depressed or anxious. A mental health counselor and support groups can help.

Treatment For Breast Cancer Recurrence

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If your care team thinks you might have a cancer recurrence, theyll recommend diagnostic tests, like lab tests, imaging or biopsies, both to be sure the cancer has come back and to get more information to guide your treatment.

Treatment options depend on where the cancer has recurred and what treatment youve had before:

  • Local recurrence is likely to be treated surgically first with a mastectomy if you didnt have one already or a surgical removal of the tumor if you did. After surgery, chemotherapy and radiation are commonly used, as well as hormone therapy or targeted therapy if your kind of cancer will respond to one or both of them.
  • Regional recurrence is also typically treated first with surgery to remove affected lymph nodes. After the surgery, youll likely have radiation and possibly chemotherapy, hormone therapy and/or targeted therapy, too.
  • Distant recurrence is mainly treated with drug therapychemotherapy, hormone therapy, targeted therapy or a combination of these. Surgery and/or radiation might be used, too, but only in cases where the aim is relieving symptoms.

Expert

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Dcis Has The Same Risk Factors As Invasive Breast Cancers

“The same things that increase a woman’s risk for DCIS are really the same things that increase her risk of invasive breast cancer,” says Dr. Meyers. For example, having a strong family history can be a factorespecially if a woman tests positive for a high-risk BRCA gene mutation.

Women who have a longer period of estrogen stimulation, meaning they started menstruation early and/or entered menopause late, also have an increased risk of DCIS as well as invasive cancer. That also goes for women who don’t have children, or who have their first pregnancy after age 30.

Distant Breast Cancer Recurrence

Distant breast cancer recurrence is when the cancer has spread to another organ within the body. Breast cancer that has spreadalso called metastatic breast canceris no longer curable and needs to be managed as a chronic disease. There are various treatment options to control the cancer and stop its progression, prolonging a patients life and improving quality of life. These treatments may include:

  • Chemotherapy
  • Small molecule inhibitors
  • Clinical trials

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How Does Distant Recurrence Occur

Many patients find it hard to understand how they can be apparently cancer free one day and be diagnosed with recurrent cancer the next. If surgery got all of the cancer out and chemotherapy and radiation were supposed to have mopped up the rest, how can recurrence even happen?

In most cases, even the smallest breast cancer detected has been growing for some time before it was caught. During this period of growth, the cancer cells multiplied and divided over and over again, and some cancer cells may splinter off from the main tumour and escaped into the surrounding blood and lymphatic vessels. Cells that spread to lymph nodes can certainly be trapped in those lymph nodes and removed at the time of surgery, but cells can also go into the circulatory system. Even early-stage cancers that originally had no lymph node involvement can recur and develop metastatic disease.

While its less common, cancer cells can bypass lymphatics and lymph nodes and travel via surrounding blood vessels. Cancer cells can continue to circulate and go anywhere the blood vessels will take them, or they can home in on other organs in the body, where they take up residence and continue to grow and divide in that one particular spot.

If and when cancer comes back, the cancer cells that escaped the breast are to blame. Obviously if your recurrence is ten years after your diagnosis, we assume that the cells have been dormant all that time and missed the treatments aimed at dividing cells.

Cellular And Tumour Mass Dormancy

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Two different models of tumour dormancycellular and tumour mass dormancyhave been proposed. Cellular dormancy refers to the presence of solitary or small cell clusters of DTCs that exist in a G0/G1 growth-arrested state and result from quiescence, senescence or differentiation. An inability to properly adhere to the ECM,, reduced signalling through the phosphatidylinositol 3-kinase /AKT pathway and a low ratio of the extracellular signal-regulated kinase to the stress-induced kinase p38, are some of the plethoras of predominantly cell-intrinsic mechanisms that have been reported to induce cellular dormancy. On the other hand, escape from cellular dormancy has been shown to occur upon increased matrix stiffness through TGF1 expression, following the release of neutrophil extracellular traps by inflammatory neutrophils, and as a result of aberrant activation of the adhesion protein vascular cell adhesion protein 1 in indolent breast DTCs lodged in the bone marrow via engaging 41-expressing osteoclasts.

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Surgery For Breast Cancer

Most women with breast cancer have some type of surgery. Common types of breast surgery are lumpectomy, mastectomy, and taking out lymph nodes from the underarm. Women who have a mastectomy may also decide to have the breast shape rebuilt, either at the same time or later on.

Choosing between lumpectomy and mastectomy

Lumpectomy only takes out the lump and a little bit around it. It lets you keep most of your breast. The downside is that youll most likely need radiation treatment after surgery. But some women who have a mastectomy also need radiation afterward.

When choosing between a lumpectomy and mastectomy, be sure to get all the facts. At first you may think that a mastectomy is the best way to get it all out. Some women tend to choose mastectomy because of this. But in most cases, lumpectomy is just as good as mastectomy. Talk to your cancer care team. Learn as much as you can to make the right choice for you.

Reconstructive surgery

If you have a mastectomy, you may want to think about having your breast shape rebuilt. This is called breast reconstruction. Its not done to treat the cancer. Its done to build a breast shape that looks a lot like your natural breast.

If youre going to have a mastectomy and are thinking about having reconstruction, you should talk to a plastic surgeon before the mastectomy is done. Your breast can be rebuilt at the same time the mastectomy is done or later on.

Side effects of surgery

How Is Recurrent Breast Cancer Diagnosed

Many women who have had breast cancer in the past pay close attention to their bodies and are very aware of even the smallest changes. But many physical changes or health problems have nothing to do with the cancer they had before. Signs of breast cancer recurrence may include a lump in the breast, scar tissue or the chest area, as well as inflamed skin. Some women will notice these changes themselves, or a doctor might find them during an examination, for example during a check-up.

If you suspect that your breast cancer has come back, your doctor is the first person to go to. You might be referred to a hospital, tumor center or certified breast center for additional tests. If you are no longer at the same practice or center where you were treated for breast cancer the first time, it is important to bring along as much information as possible about your previous treatment. You can also consent to doctors sharing the relevant information about you with each other.

After a detailed talk about your medical history, you will have a physical examination, mostly to inspect the breast or the surgical scar. If breast cancer has come back, your doctor will also check whether the tumor has spread to the other breast or any other parts of your body. Any abnormalities in the body will be examined more closely. The breast cancer will then be classified using certain criteria, in the same way that it was when you first had this disease.

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Treating A Metastatic Recurrence

Many treatments exist for metastatic breast cancer. Your options will depend on where your cancer has spread. If one treatment doesn’t work or stops working, you may be able to try other treatments.

In general, the goal of treatment for metastatic breast cancer isn’t to cure the disease. Treatment may allow you to live longer and can help relieve symptoms the cancer is causing. Your doctor works to achieve a balance between controlling your symptoms while minimizing toxic effects from treatment. The aim is to help you live as well as possible for as long as possible.

Treatments may include:

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